Healthcare Provider Details

I. General information

NPI: 1891153037
Provider Name (Legal Business Name): KAY KITAZUMI P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

IV. Provider business mailing address

170 NIUIKI CIR
HONOLULU HI
96821-2349
US

V. Phone/Fax

Practice location:
  • Phone: 808-373-3555
  • Fax: 808-373-3666
Mailing address:
  • Phone: 808-351-6659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1972
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: